DID YOU KNOW THAT YOUR HEALTH INSURANCE PREMIUM  
         DEPENDS ON WHERE YOU RESIDE!! 
          
          
          
         WHAT IS HEALTH INSURANCE AND WHY IS IT NEEDED? 
          
         Up to the mid 80’s, most of the hospitals in India were Government owned and treatment was free of cost. With the advent of Private Medical 
         Care, the need for Health Insurance was felt and various General Insurance Companies (New India Assurance, National Insurance Company, 
         Oriental Insurance & United Insurance Company) introduced Health (Mediclaim) Insurance as a product.  
          
         Health Insurance, also known as medical insurance is a form of insurance which covers the expenses incurred on medical treatment and 
         hospitalisation.  It  covers  the  individual  and  family  against  any  financial  constraints  arising  from  medical  emergencies.  In  case  of  sudden 
         hospitalisation, illness or accident, health insurance takes care of the expenses on medicines, oxygen, ambulance, blood, hospital room, various 
         medical tests and almost all other costs involved. Thus, by insuring one’s health, by paying a premium every year according to your age,  you  
         ensure that till a certain limit, the medical expenses, would be covered by the insurance company and  you will not have to spend it from your own 
         pocket. 
          
         Health (Mediclaim) Insurance pays for medical expenses. It is used more broadly to include insurance that covers disability or long-term nursing 
         or custodial care needs. In simple words, if you are covered under Health (Mediclaim) Insurance, you pay some amount of premium every year to 
         an insurance company and if you have an accident or if you have to undergo an operation or a surgery, the insurance company will pay for the 
         medical expenses. 
          
         It takes just one visit to a hospital to make you realize how vulnerable you are if you are diagnosed with an illness and need to be 
         hospitalized, no matter if you are rich or poor, male or female, young or old. The list of lifestyle diseases today seems to get longer and more 
         common.  . Thankfully there are more specialty hospitals and specialist doctors – but all that comes at a cost.   This is where Health Insurance can 
         help you to tide over your problems! 
          
         Types of Health (Mediclaim) Insurance 
          
         There are mainly 3 types of Health (Mediclaim) Insurance covers which are as follows. 
          
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       (1) Individual Mediclaim:  
        
       This is the  simplest form of health insurance covering  the hospitalization expenses for an individual up to the sum assured limit. The premium is 
       dependent on the sum assured. It is a cover which takes care of medical expenses following Hospitalization / Domiciliary Hospitalization of the 
       insured in case of sudden illness, accident and any surgery which is required in respect of any disease which has arisen during the policy period. 
       This cover is a hospitalization cover and reimburses the medical expenses incurred in respect of the covered disease / surgery while the insured 
       was admitted in the hospital as an inpatient. The cover also extends to pre- hospitalization and post- hospitalization for periods of 30 days and 60 
       days respectively.  
       Example: If a family has 4 members you can take an individual cover of Rs. 2 lakhs each for each member. Each member is now covered for 2 
       lakhs. If all the 4 members are hospitalized, all 4 of them can get expenses recovered up to Rs 2 lakhs each. All the 4 policies are independent. 
        
       (2) Family Floater Policy:  
       Family Floater Policy is an enhanced version of the mediclaim policy. The policy covers each family member and the entire family’s expenses are 
       covered up to the sum assured limit. The family floater plan’s premium is less than the separate insurance cover for each family member.  
       Example: If a family of 4 takes a family floater policy of Rs. 8 lakhs, they can claim medical expenses up to Rs. 8 lakhs in that policy year. If one 
       person is hospitalized and claims Rs. 3 lakhs, it will be paid, but they will be left with only Rs. 5 lakh worth of medical expenses that can be 
       reimbursed in that year. The next year, the policy will start with a fresh Rs. 8 lakhs. So, in many ways the family floater plan offers flexibility in 
       terms of utilizing the overall insurance coverage among the group. 
        
       (3) Unit Linked Health Plans:  
        
       Health Insurance Companies have introduced Unit Linked Health Plans which combine health insurance with investment and pay back an amount 
       at the end of the insurance term. The returns are dependent on market performance. These plans are new and still in development phase.  Only 
       people who can handle market linked products like ULIP and ULPP are recommended to take this plan. 
       For a number of reasons, it is advisable to stay clear of unit linked health plans. Treat insurance purely as an expense. Opt for an 
       Individual Mediclaim policy if you are single and opt for a Family Floater policy if you have family. Health (Mediclaim) Insurance 
       premiums come under tax exemption under section 80D for a maximum of Rs. 15, 000/-.  
       What is the Ideal Cover for Health Insurance 
       The cost of Health Insurance depends on the sum assured, age, current health condition and your previous medical history. The premium will be 
       high if the sum assured is high. So what should be the ideal health insurance cover requirement? There is no standard answer for this. 
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        If health insurance is important, one has to look at one’s own lifestyle, health condition, age, family history of illnesses and affordability. Most 
       insurance companies limit the sum assured to a maximum of Rs. 5 lakhs.  
        
       Many health insurance policies “provide additional benefits” such as daily allowance, ambulance charges, etc. for hospitalization which 
       are superfluous and a high premium is charged for this. Hence avoid such plans and take something simple and basic. 
        
       Health Insurance provided By the Employer 
       Many employers provide health cover for their employees. There are 3 aspects which need to be considered in such a case 
           Is that cover sufficient? Is the insurer good enough?  
           What happens if you change your job?  
           Health insurance is provided as perk to the employees  
           So an employee has to understand the policy in detail and check for coverage. 
            Ask the HR Department for policy details. Get into details and find out what is covered 
            and what is not covered.  
           Often employees just think that the employer has given them health insurance and are relaxed. Later they find out that it does not 
           cover A and covers B only up to a limit, which can be a painful situation. 
        Health Insurance for the Aged 
       Health insurance companies were reluctant to provide cover for the aged till a few years back. But these days, a lot of insurance companies are 
       providing policies for senior citizens. Additional tax exemption of up to Rs. 20, 000/- is provided for the insurance cover paid for a person of age 
       65 years and above. But the senior citizens have to pay high premium rates. For the employed, another option is to approach the employer to 
       negotiate with the official insurer to provide an option for additional cover to parents. Since the volumes are high, the insurer can provide such 
       added cover at attractive premium rates. 
        
        Tax Exemption from Health Insurance Premiums 
       Sec 80D covers Health Insurance. You can get exemptions of: 
        
       (a) Up to Rs. 15,000 paid for self + spouse + children. 
        
       (b) Up to Rs 15,000 paid for Parents (Rs 20,000 if parents are senior citizens) 
        
       So in total if you pay your health insurance and your parents’ health insurance premiums, you can save up to maximum of Rs. 35, 000/-. 
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       Note: If you take Health Insurance riders with Term Insurance like Critical Illness cover, the extra premium paid for that will actually be covered 
       under Sec 80D and not under Sec 80C.  
        
        
       Third Party Administrators (TPAs) – The link between  you and the Insurance Company 
        
       TPA stands for Third Party Administrator. TPA is a middleman between Insurer and the Customer. At the time of claim, the customer can directly 
       deal with the TPA and the TPA will help them with all the process of claim settlement.  
        
       A TPA is a specialized health service provider providing a variety of services like networking with hospitals, arranging for hospitalization and 
       claim processing and settlement. The concept was introduced by the Insurance Regulatory and Development Authority of India (IRDA) for the 
       benefit of both the insured and the insurer. While the insured is benefited by quicker & better health service, insurers are benefited by reduction in 
       their administrative costs, fraudulent claims and ultimately bringing down the claim ratios. An insurance company can have more than one TPA 
       and a TPA can serve more than one insurance company.  
        
       Some of the services provided by the TPA are: 
       (1) Maintaining database of policyholders 
       (2) Issuing of ID cards to all policyholders 
       (3) Providing ambulance service 
       (4) Providing information to policyholders about hospitals 
       (5) Checking various investigations 
       (6) Providing cashless service 
       (7) Processing claims  
       Health Insurance Claims Settlement Process 
        
       In most cases, the Insurance companies appoint a Third Party Administrator (TPA) for claims processing. Once the health insurance policy is sold, 
       the insurer passes on  complete details to the TPA. In case of a claim, the insured has to get in touch with the TPA for all verification and 
       formalities to get the claim settled. 
        
        Two Ways By Which Health Insurance Claims Are Settled: 
        
       (1) Cashless For planned hospitalization at authorized network hospitals, the TPA has to be notified in advance for availing cashless treatment or 
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